Abstract

SESSION TYPE: Pediatric Pulmonology Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Obstructive sleep apnea (OSA) and asthma are prevalent conditions in children associated with significant cardiovascular and neurocognitive morbidities. Previous studies demonstrated that these two conditions share common pathophysiology and are both seen in a significant number of children. Furthermore, OSA can worsen asthma, and vice versa. Studies in adults with OSA showed improvement in asthma when continuous positive airway pressure (CPAP) was initiated. Recent studies in children reported that adenotonsillectomy (T&A) is associated with improvement in OSA and asthma symptoms. Our study is to determine if T& A improves lung function of children with OSA and asthma.

METHODS: Children 7-21 years old with asthma and signs of OSA were referred for polysomnography (PSG). T&A was recommended if OSA was documented by PSG. Presence of co-morbid illnesses ie obesity, reflux, rhinitis and smoking exposure was reviewed. Patients were classified as Group I (+)T&A or Group II (-) T&A if surgery was done or not done within one year from PSG, respectively. Baseline and follow up FEV1 and FEV1/FVC were measured. Regression analyses were performed to assess association between T&A and lung function (FEV1, FEV1/FVC). Statistical significance was set at P <0.05 to detect an increase in FEV1 by 10%.

RESULTS: A total of 105 asthmatic children were referred for sleep study for suspected OSA. Twenty-four patients with PSG-documented OSA (AHI >1/hour) required T&A. Moderate and severe persistent asthma were found in 79% of patients. Majority (83%) of patients were obese. There were 11 and 13 patients in Group I and Group II, respectively. Asthma score using Asthma Therapy Assessment Questionnaire (ATAQ) trended towards improvement with T&A. However, there was no significant increase in the lung function post T&A (FEV1 OR 0.44 P=0.35; FEV1/FVC OR 0.44 P=0.39) after adjusting for body mass index (BMI), reflux, rhinitis and smoking exposure.

CONCLUSIONS: After adenotonsillectomy, perception of asthma seem to improve, but lung function did not significantly improve. Recruitment of additional subjects is ongoing.

CLINICAL IMPLICATIONS: T&A improves OSA and likely to reduce symptoms of asthma. However, lung function is an objective measure of a well controlled asthma- a major goal for every asthmatic child.

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